Page 127 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

hook through the tissue such that the barb re-emerges in
the lumen. The hook can then be rotated entirely into the
VetBooks.ir attempt should be made to advance it into the stomach if
lumen and retrieved.
If an oesophageal foreign body cannot be extracted, an
there is little risk of causing a perforation. Bones will be
digested in the stomach and do not require a gastrotomy for
retrieval, unless they subsequently cause a clinical problem.
If an endoscope is not readily available, similar tech-
niques for the retrieval of oesophageal foreign bodies using
fluoroscopic guidance are described (Hotston Moore, 2001).
Non-surgical retrieval of oesophageal foreign bodies
can be performed in most cases. In one clinical series of
dogs, in which endoscopy was employed, foreign bodies
were extracted in 86% of dogs (57 of 66), and pushed
into the stomach in 14% (Gianella et al., 2009). Similar
results have been reported using fluoroscopic tech-
niques, with foreign bodies being extracted in 84% of
dogs (51 of 61) (Hotston Moore, 2001). In another report,
(a)
fishhooks were successfully extracted endoscopically in
Oesophageal foreign 64% of animals (23 of 36) (Michels et al., 1995).
9.1
body. (a) Lateral
thoracic radiograph of a
1-year-old Shih-Tzu with a 5-day Surgery
history of regurgitation,
drooling and di culty Surgical intervention is indicated:
swallowing. The radiograph
shows an oesophageal foreign • When retrieval or advancement of the foreign body fails
body lodged in the caudal • When forceps extraction presents a significant risk for
thoracic oesophagus. laceration of the oesophagus or major vessels
(b) Endoscopic appearance of
the oesophageal foreign body • When the foreign body has perforated the oesophagus.
(a bone).
(b) (Courtesy of the Veterinary Imaging Oesophagotomy: The surgical site is isolated with mois-
Database, University of California, Davis) tened laparotomy sponges. An orogastric tube is passed
and the oesophagus cranial to the foreign body is suc-
initial treatment of choice for oesophageal foreign bodies tioned to reduce contamination. Stay sutures can be posi-
unless perforation is highly suspected. A flexible endo- tioned lateral to the intended oesophagotomy site for ease
scope is preferred for examining the oesophagus but of tissue manipulation. A stab incision is made into the
either a flexible or rigid endoscope can be employed oesophageal lumen and extended longitudinally or trans-
to retrieve the foreign body. The clinician must have the versely as necessary (Figure 9.2). If the oesophageal wall
ability to insufflate air through the endoscope to dilate appears normal, the incision is made directly over the
the oesophagus around the foreign body. If oesophageal foreign body, whereas if the oesophageal wall appears
perforation is suspected, insufflation should be avoided or compromised, the incision should be made caudal to the
used sparingly owing to the serious risk of iatrogenic foreign body. The foreign body is removed with forceps,
pneumomediastinum and possibly pneumothorax (Gianella taking care to avoid further oesophageal trauma. In cases
et al., 2009). Arterial haemoglobin oxygen saturation, of sharp bone foreign bodies, incremental removal of the
arterial blood pressure and the ease and rate of ventilation foreign body using rongeurs may aid in preventing further
should be monitored during oesophagoscopy, because trauma to the oesophagus.
tension pneumothorax can occur during endoscopic The oesophageal lumen is carefully inspected for
oesophageal insufflation if a perforation is present. areas of perforation or necrosis. The oesophagotomy inci-
Periodic suctioning of the insufflated air from the stomach sion can be closed with a single- or two-layer simple
may be required to promote adequate ventilation. interrupted suture pattern (Figure 9.2). With a two-layer
There are various techniques utilized when endosco- pattern, the first layer incorporates the mucosa and sub-
pically removing an oesophageal foreign body. Most mucosa and the knots are placed in the oesophageal
commonly, the foreign body is grasped with rigid forceps lumen. The second layer apposes the muscularis and
passed alongside the endoscope or through an instrument adventitia, with the knots placed on the external surface
channel. The foreign body is gently rotated to free it, and of the oesophagus. With a single-layer closure, the suture
then withdrawn with the scope, with any sharp points or passes through all layers of the oesophageal wall, with
edges facing caudally. A firmly lodged foreign body should limited penetration of the mucosa, and the knots are
not be forced, as this may induce or enlarge a perforation. placed extraluminally. Sutures should be placed approxi-
An alternative technique described for relatively smooth mately 2 mm from the cut edge and 2–3 mm apart. The
foreign bodies is to pass a balloon catheter distal to the integrity of the closure can be tested by distending
foreign body, inflate the balloon, and gently apply traction the oesophagus with saline and placing additional sutures
to withdraw the catheter and foreign body. to seal any areas of leakage.
For the endoscopic retrieval of fishhooks, the neck of
the hook is grasped with rigid forceps. The hook is pulled Gastrotomy: Foreign bodies located between the heart and
close to the endoscope and then withdrawn with the endo- diaphragm can also be removed via a gastrotomy per-
scope. An attempt should be made to dislodge a fish - formed through a midline laparotomy (Taylor, 1982). See the
hook embedded in the oesophageal wall by rotating the BSAVA Manual of Canine and Feline Abdominal Surgery.

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